Medical Mystery Monday #137: The case of the aching back.

Hello medical mystery readers! Today’s case lets you be the medical student and try your hand at diagnosing our patient’s condition. Can you think of what might be responsible for all of her symptoms?

A 23 year old female graduate student presents to her primary care doctor complaining of pain in her lower back that has been getting steadily worse for the last several weeks. An avid runner, the patient reports she can no longer make it further than a few blocks before the pain becomes so severe that she has to stop. She has no significant past medical history, and generally considers herself to be in excellent health. 3 years ago, as a college junior, she spent 2 semesters in India as part of a study abroad program. When pressed by the doctor about any additional symptoms, the patient describes waking up in the middle of the night soaked in sweat several times over the last few weeks. She also remarks that she might be losing weight, since recently her appetite has been off and her jeans have started to fit more loosely around her waist. On physical exam the patient seems uncomfortable sitting up, and the doctor notices a slight bulge protruding from her lower spine. Her vital signs are all normal with the exception of her temperature, which is mildly elevated. To better characterize the patient’s complaint, the doctor orders an X-ray of the patient’s back and sees the following:

From: mevis-research.de

Now suspecting a particular disease process, the doctor administers a certain test to the woman and informs her that her diagnosis should be confirmed within 48 hours.